Shetland COVID-19 Outbreak Control Plan

Shetland COVID-19 Outbreak Control Plan October 2020 Foreword Our Local Outbreak Plan builds on existing health protection plans and sets out the measures that have been put in place to protect the public’s health and contain any outbreak.

It sets out how Shetland Islands Council, NHS Shetland, businesses, voluntary agencies and our local communities are working together to prevent, manage, reduce and suppress outbreaks of COVID-19 in Shetland. It also provides clarity about our individual and collective responsibilities for delivering this plan and responding to an outbreak.

A key feature of our plan is the importance of partnership and collaborative working, sharing data and information to make sure we have early warning of any increased transmission, and the established processes we use with all partners to respond quickly for effective management of incidents and outbreaks. The plan also outlines our approach to testing and contact tracing, which is an integral aspect of our strategy to reduce onward transmission of COVID-19.

Together we have learned from our experience of COVID early on in the pandemic and worked hard to make sure that our most vulnerable residents are supported to stay safe within their local community. As we enter the next phases of the pandemic, this plan explains how we have and will continue to keep people safe in high risk workplaces, locations and communities.

I would like to thank you all for the part you have already played in reducing the virus in our communities. Being vigilant about hygiene, maintaining physical distancing, getting tested when you have symptoms and self-isolating when needed will be an essential part of the way we live our lives for some time to come. Without your support for these measures, many more people would have been infected and many more may have sadly died. We need you to continue following this guidance for this Outbreak Plan to be effective.

COVID-19 has impacted on the lives of everyone on our islands. The collective effort, expertise and commitment of partners and communities has and will continue to limit the impact of COVID- 19 in Shetland.

Stay safe, Susan Webb Director of Public Health, NHS Shetland

Table of Contents Foreword ...... 1 Introduction ...... 3 Our Approach ...... 8 Our Plan ...... 10 Theme 1: Data and Surveillance ...... 11 Theme 2: Cluster and Outbreak Management ...... 13 Theme 3: Prevention and Precautions: Care Homes ...... 15 Theme 4: Prevention and Precautions: Educational Settings including Early Learning and Childcare & Out of School Care ...... 17 Theme 5: Prevention & Precautions: High Risk Places, Locations & Communities of Interest ...... 18 Theme 6: Prevention and Precautions: Port Health ...... 19 Theme 7: Detection: Test and Protect ...... 21 Theme 8: Care for People ...... 24 Theme 9: Local Governance ...... 26 Communicating Our Plan ...... 27 Where do I go for more information? ...... 29

Introduction Novel Coronavirus disease (COVID-19) is an infectious disease caused by a newly discovered coronavirus. It is highly infectious and has spread rapidly to almost every country in the world.

The first wave of the pandemic resulted in over 400,000 infections across the UK population. In the Shetland Islands there were 54 cases between March and April 2020, with a further six cases reported between April – September 2020. Little is known about how immunity to the virus develops or how long it lasts for following an infection. Work on vaccine development is ongoing, with a number of vaccines currently being tested.

In the meantime, it is likely that the virus will continue to circulate, possibly causing periodic epidemics which cannot be prevented without intervention measures.

The aim of our plan is to:

• Save lives. • Reduce and control the spread of infection as quickly as possible; and • Support and minimise the impact that the virus is having on our most vulnerable groups.

This plan sets out how we will prepare, respond and adapt to restrictions and a new reality, allowing schools to remain open, young people to attend college and businesses to operate while also continuing to protect against the spread of the disease. We will act within the context of guidance from Scottish Government which may include specific restrictions on businesses and social interactions as further waves of the pandemic evolve.

This is a Shetland plan that builds on the strong relationships and approaches already in place with key public partners for tackling situations locally during the pandemic. Amongst these partners are: • Shetland Islands Council • Public Health Scotland • Shetland Health and Social Care Partnership • Shetland Emergency Planning Forum Executive • NHS Shetland • Community Planning Of course, public partners cannot fight this virus alone and we require the business community to ensure compliance with all sector specific guidance issued by the Scottish Government. We therefore continue to look to business representative bodies such as Business Gateway, Living Lerwick and Third sector partners to support businesses in their awareness of all the guidance.

Essential to our fight against this virus, are our civic and religious partners and of course, the media for ensuring the public fully understand the complex public health advice. And finally, our residents and visitors to the islands – you are critical.

Source: https://public.tableau.com/profile/phs.covid.19#!/vizhome/COVID- 19DailyDashboard_15960160643010/Overview

We Can All Play Our Part Keeping informed and knowing the latest advice on preventing the spread of COVID-19. This means feeling confident about what the basic steps are – washing your hands often, physical distancing, limiting contact and wearing your face covering where you cannot maintain that distance, self-isolating and requesting a test if you develop COVID-19 symptoms.

You can find more information on the Scottish Government website: www.gov.scot/coronavirus-covid-19.

If you are part of a business, voluntary or community group, make the most of the guidance available from Scottish Government and other relevant agencies to help keep yourself, your employees, and members of the public safe. Signpost others to these resources too and share them on social media where you can.

Be familiar with what to do when you or someone you know has symptoms. Share basic advice on what to do about self-isolating, getting tested or being a close contact with others where you can.

If you or someone you know might need extra help while they are self-isolating, you can find out how to get additional support at www.shetland.gov.uk/communityplanning/CoronavirusSupportForCommunities.asp or call the Shetland Coronavirus Hub telephone number on 0800 030 8780.

The National Assistance Helpline may also be helpful: 0800 111 4000 (Mon – Fri 9am – 5pm) or via textphone on 0800 111 4114. If your business has been affected by coronavirus and you need support, visit www.findbusinesssupport.gov.scot.

All our public sector partners on the islands will continue to work together to manage any outbreak that occurs on the islands. If you are in a higher risk category or more complex setting, we will be supporting you directly. For everyone else, please continue to stay alert and look out for each other as we all work together to keep our islands safe.

NHS Shetland and Shetland Islands Council will continue to work together to make sure that our residents, communities, and local businesses and organisations have the information and tools they need to stay safe whilst living with COVID-19.

We will support our islands to: Understand the level of risk faced by an individual; Understand the risk posed by an environment or place; Know what to do if someone becomes unwell with COVID-19 symptoms; and Access resources to support places to operate safely.

Coronavirus symptoms and how to get a test

Coronavirus symptoms: • New high temperature (fever) • New continuous cough • New loss or change in sense of smell or taste

If you have coronavirus symptoms: If you develop a continuous cough, high temperature, or loss or change in taste or smell, you should not attend your local GP practice or Emergency Department. You should stay at home, self-isolate and request a coronavirus test straight away.

You can request a test online by going to the NHS Shetland website and clicking on the ‘Self-refer for a COVID test’ www.shb.scot.nhs.uk/ This is the quickest and easiest way to get a test done. Once you have filled in the form online our local testing coordinator will organise your test and contact you to let you know what will happen next.

If your test is positive you will need to self-isolate for at least for 10 days. Others in your household must self-isolate for 14 days in case they also develop symptoms.

If your symptoms worsen or last for more than 10 days, call NHS 24 on 111. If you have a fever for more than 10 days, continue isolating for 48 hours after it ends.

Box 1 Coronavirus symptoms and how to get a test

Our Approach Our approach will continue to build on the strong and established relationships and approaches already in place with key partners for tackling situations locally during the pandemic. We refer to the multi-agency group which comes together to coordinate emergency responses as the Shetland Emergency Planning Forum Executive (SEPFE). The SEPFE consists of organisational representatives who are best placed to deliver the required outcomes and the most effective response. These organisations include:

• Shetland Islands Council • Scottish Ambulance Service • NHS Shetland • Maritime and Coastguard Agency (MCA) • Police Scotland • Scottish Environment Protection Agency (SEPA) • Scottish Fire & Rescue Service

The SEPFE, via the North of Scotland Regional Resilience Partnership (consisting of the Highlands and Islands Local Resilience Partnership (LRP), Grampian and Tayside LRP) structure facilitates close working with Scottish Government and assists responders to manage the multi- agency nature of the response, make joint decisions and act in a unified manner.

Scale

Communication and Capacity Engagement

Integration and Stakeholders Delivery

This plan also brings in additional principles tailored to the current COVID-19 pandemic that underpin our approach:

Scale – we have increased our traditional health protection and emergency response arrangements to ensure that we can respond to outbreaks quickly, potentially managing multiple outbreaks at the same time.

Capacity – we will utilise the specialist skills, capability, and expertise available to us from our partners and ensure that this is appropriately resourced. This may include additional capacity and mutual aid between partners including other health boards and local authorities where necessary. Our local capacity is increased, when required, through the resources which the Scottish Government puts at our disposal.

Stakeholders and partners – we will provide clarity for our partners and stakeholders so that individual and collective responsibilities for the delivery of the plan are clear. This includes understanding their response in the event of an outbreak.

Integration and delivery – Through the Shetland Emergency Planning Forum Executive all partners will ensure connections are maintained with regional and national resilience infrastructure. Where possible, outbreak management responses will be consistent amongst partners across the Islands whilst being flexible enough to adapt to specific circumstances / settings.

Communication and Engagement – we will engage with our partners and wider communities to build confidence in the proactive and reactive nature of our plan. This will include ongoing opportunities for feedback from our partners to support learning and continued improvement.

Our Plan Our plan provides a framework for the response to COVID-19 incidents and outbreaks that occur in the Shetland Islands. It is structured around nine interconnected themes and will evolve with the pandemic.

Theme 1: Data and Surveillance Ensuring access to the right local data to support planning, prevention and management of outbreaks.

Theme 2: Cluster and Outbreak Management Coordinating arrangements to prevent the spread of COVID-19 and proactively manage outbreaks.

Theme 3: Prevention and Precautions in Care Homes Ensuring outbreaks are prevented and managed effectively in care homes, taking a proactive approach wherever possible.

Theme 4: Prevention and Precautions in Educational Settings Preventing and managing outbreaks in educational settings, taking a proactive approach wherever possible.

Theme 5: Prevention and Precautions in High Risk Workplaces, Locations and Communities Helping to keep as many services and businesses as possible operating in a way that is safe and supports the recovery of our local economy by preventing and managing outbreaks in high-risk locations, workplaces and communities.

Theme 6: Prevention and Precautions in Port Health Preventing and managing outbreaks associated with sea and air travel by taking a proactive approach wherever possible.

Theme 7: Detection: Test and Protect Test and Protect is a national strategy aimed at managing the spread of COVID-19 by quickly identifying cases of the virus and breaking the chains of transmission. We will use local, regional and national testing capacity to best meet current and potential demand for contact tracing and outbreak management.

Theme 8: Care for People Supporting vulnerable people to stay safe and get help to self-isolate. This also means ensuring services meet the needs of diverse local communities.

Theme 9: Local Governance Taking local actions to contain outbreaks and communicate effectively in a timely, accessible manner with the general public.

Theme 1: Data and Surveillance The World Health Organisation (WHO) highlights the importance of public health controls and advocates six criteria for health systems to fulfil as lockdown restrictions ease (see Box 2). The first two criteria require data and intelligence, including information from a test, trace, isolate, support system, whilst also ensuring processes are in place to minimise risk of outbreaks in highly vulnerable settings. WHO criteria for easing lockdown restrictions

1. Evidence shows COVID-19 transmission is controlled; 2. Public health and health system capacities are in place to identify, isolate, test, trace contacts and quarantine them; 3. Outbreak risks are minimized in high-vulnerability settings, particularly in homes for older people, mental health facilities and crowded places of residence; 4. Workplace preventive measures are established, including physical distancing, handwashing facilities and respiratory etiquette; 5. Importation risks can be managed; and 6. Communities have a voice and are aware, engaged and participating in the transition.

Box 2 WHO criteria for easing lockdown restrictions Surveillance An essential part of incident management is the recognition of a change in the distribution of illness or the occurrence of an illness of major public health significance. Surveillance is the term used to describe several activities involving the collection, collation, analysis and sharing of information and intelligence on infection spread within the general population and communities. Surveillance enables early identification of all COVID-19 cases to allow rapid contact tracing, which is the main method used to try to prevent and stop outbreaks occurring. A daily dashboard has been created by Public Health Scotland to support surveillance. The dashboard contains the latest statistics on cases of COVID-19 reported by NHS Scotland and UK Government Regional Testing Centre laboratories. It is available here: https://publichealthscotland.scot/our-areas-of-work/sharing-our-data-and-intelligence/coronavirus- covid-19-data-and-guidance/ In Shetland we also use other data sources such as school absences and requests for testing to provide early warning signs of a potential outbreak. What NHS Shetland Public Health have done so far: Our public health surveillance effort has involved collaboration between NHS Shetland, Shetland Islands Council, NHS Grampian, Public Health Scotland and the Aberdeen Centre for Health Data Science. Early in the pandemic we applied the tools that were developed by our partners to: • Model the potential effects of the pandemic to inform care planning. • Develop planning intelligence for the next phases of the pandemic and recovery.

What we will do now: • Continue collaborating with our partners and prepare for a range of possible scenarios to manage health and care during winter. • Develop accessible intelligence at a local level to help us prepare for any increased demand and to mobilise quickly when needed.

Theme 2: Cluster and Outbreak Management Scotland is now in a situation where, after a more controlled period, there continues to be widespread transmission in the general population, indicating that we cannot afford to become complacent and the risk of an uncontrolled COVID-19 resurgence remains a threat for the conceivable future. In this current phase three of the Scottish Government’s transition out of lockdown, we need to be able to react to incidents involving individual cases, clusters (two or more cases linked in time and place) and outbreaks (two or more cases linked in time and place with a suspected common source) of infection in order to limit further spread and protect public health, especially the health of those who are most vulnerable. Incident Management Strong local and national partnerships are already long-established to ensure effective and coordinated incident management. This is based on many years of experience in dealing with a wide range of public health incidents ranging from food poisoning to more complex problems such as outbreaks of flu in care homes and norovirus in schools. • NHS Shetland’s Public Health (Health Protection) Team is responsible for the management of local incidents. • The Public Health Team investigates cases, clusters and outbreaks and undertakes rapid information gathering and risk assessment to decide if a multi-professional / agency response should be convened. Problem Assessment Group In some circumstances NHS Shetland Public Health will convene a Problem Assessment Group (PAG) to undertake an initial investigation and assess the situation before declaring an incident or outbreak. For example, we may convene a PAG if a person who works in a school or care home tests positive for COVID-19. This will enable us to assess what actions need to be taken to prevent further spread. Incident Management Team Where there is a confirmed incident, such as a cluster or outbreak, an Incident Management Team (IMT) is called by the Public Health Team and usually chaired by a Consultant in Public Health. The IMT is an independent group with responsibility for analysing relevant data, investigating and managing the incident. The IMT Chair has overall responsibility for managing a public health incident and will coordinate the activities of other agencies as required.

The IMT includes the following membership: • NHS Shetland – the Public Health team, Corporate Communications team and the Infection Control Team if appropriate: along with representatives from other parts of the organisation if relevant; • Shetland Islands Council – the Environmental Health team and representatives from other departments if relevant (e.g. Education for cases in a school, or Social Care for cases in a care home); • Public Health Scotland; • Scottish Government COVID-19 Outbreak Team • Representatives from other organisations affected by the incident. The size and nature of the incident will determine the arrangements and some tasks may be delegated to other agencies.

• Where data suggests that there is a local outbreak of COVID-19 cases, the IMT may require to disclose details of affected premises and/or workplaces in order to manage the outbreak. Such decisions will always take into account the potential distress to those impacted. • IMTs are required to notify Scottish Ministers of significant public health incidents and outbreaks. In the current context of COVID-19 this is via the Scottish Government Outbreak Team. It is necessary that Scottish Ministers are informed and engaged on local decision making relating to significant incidents. The Scottish Government Resilience teams may also be involved. • Local incidents are routinely reported to Public Health Scotland and the Scottish Government. All confirmed COVID-19 cases are automatically reported via laboratory routes, and incidents are reported via the IMTs and also daily national meetings involving Public Health Scotland and all Health Protection teams. Scottish Government Resilience Room The COVID-19 pandemic response is currently being managed in Scotland as a Level 5 incident which means that local and national decision-making and incident management are interdependent and are coordinated on a Scotland-wide basis. This means that Scottish Government emergency planning procedures have been implemented including establishment of the Scottish Government Resilience Room (SGoRR) with regular meetings of officials and Ministers. All Scottish Government activity in a national level emergency is coordinated through the SGoRR supported by relevant Directorates and Resilience Partnerships. The Coronavirus Act (2020) gives Scottish Ministers powers to issue directions to close or restrict events, gatherings and premises and gives Ministers powers to make Regulations to respond to incidence or spread of COVID-19 in Scotland. This power was used by Scottish Ministers in August. Following a meeting of SGoRR where the Grampian IMT gave advice on the local outbreak within Aberdeen, the Scottish Ministers imposed additional restrictions on the City of Aberdeen.

Theme 3: Prevention and Precautions: Care Homes Care Homes accommodate some of the most vulnerable people in Shetland and as a result can be particularly susceptible to outbreaks. Care homes play an essential role as part of the whole Health and Care system across Shetland and help to ensure hospital capacity is used appropriately. Significant work is being carried out to support people to receive care at home or in a homely environment when in need, and to ensure that people do not spend any additional time in a hospital environment other than what is absolutely essential. This is designed to enable people within restrictions to receive care and rehabilitation at home or in a homely environment. What NHS Shetland and Shetland Health and Social Care Partnership have done so far: • Established daily oversight and weekly assurance meetings involving senior members of the Shetland Health and Social Care Partnership and NHS Shetland, including the Public Health team, to ensure care homes receive the support they need in a timely manner from the most appropriate agency. • Redeployed additional staff from other roles to support service delivery. • Introduced routine weekly testing for asymptomatic care home staff as per Scottish Government policy. • Provided testing for care home residents, including for those displaying symptoms, those who are being transferred into care homes and as part of a routine surveillance programme to monitor the prevalence of COVID-19. (The latter two indications being Scottish Government policy). • Established a Personal Protective Equipment (PPE) hub to provide PPE supplies as required. • Built upon existing relationships between care homes, the NHS Shetland Health Protection team, The Hospital Infection Control team and Community Nurses, to provide guidance and support in relation to infection prevention and control. • Made training developed by the local Infection Control Team available to all care home providers via video. This supplemented the training available through completion of NHS Education for Scotland (NES) education resource ‘Turas’ infection control modules. • Rolled out assurance visits though the Assurance Huddle (who meet weekly) to ensure infection control procedures have been implemented. These visits have input from Senior managers (Community Care Resources and Community Nursing) plus locality District Nursing and a representative from the Infection Control Team.

What we will do now: • Continue prevention and containment of COVID-19 in care homes. • Review admission pathways to minimise the possibility of COVID-19 entering care homes. • Use specific national guidance for managing COVID-19 for those residents living with Dementia. • Further develop multi-disciplinary, supportive approaches and shared clinical decision making to assist care homes in maintaining the delivery of palliative and end of life care. • Maintain situational awareness and respond rapidly to changes becoming apparent through routine surveillance. • Maintain planning arrangements to support additional staff being deployed into care homes if and when the need arises through the escalation pathway detailed in the Assurance Framework. • Support care homes to improve engagement and communication with residents and their families relating to actions we may have to take at short notice, particularly in relation to meeting winter pressures and especially if combined with normal winter flu. • Continue to provide resources in the community to enable clients to continue to be cared for at home and thus prevent avoidable admission to hospital or care home. • Continue to monitor, evaluate and expand the range of activities available to residents and clients in the community to improve their overall wellbeing and resilience subject to the national restrictions currently in place relating to day services, communal activities and visiting. • Continued expansion of enhanced nutritional support through delivery of meals on wheels to reduce risk of frailty

Theme 4: Prevention and Precautions: Educational Settings including Early Learning and Childcare & Out of School Care Schools and early learning settings play an important role in children’s and young people’s lives and are vital to their development and wellbeing. There has been concern around the negative impact of school closures on children and young people’s wellbeing. In accordance with Scottish Government policy, all children, and young people, in all year groups, returned to school full-time in August. The wellbeing of all children, young people and staff has been the central focus when preparing for the reopening of schools

What NHS Shetland Public Health and Shetland Islands Council Children’s Services have done so far: • Worked together on plans and risk assessments for a safe return to school. • SIC Children’s Services has undertaken a comprehensive COVID-19 risk assessment in line with government and public health guidance which has led to:

o Enhanced cleaning arrangements and a focus on hand hygiene. o Rethinking the school day to reduce the number of children gathering at one time. o Making greater use of outdoor spaces and improving the ventilation of buildings. o Consideration of the layout and use of spaces to promote physical distancing. o Restricting entry and movement between education settings. o Consideration of business continuity planning to cope with staff impacted by Test and Protect.

o Individual planning for those who are more vulnerable or anxious. o Arrangements to provide data to inform national and local surveillance systems. • Published local guidance and answers to frequently asked questions for parents and young people to support their return to school. • Explored potential scenarios with Schools and key partners in the Shetland Emergency Planning Forum Executive to rehearse our plans and preparations for responding to cases, clusters and outbreaks. What we will do now: • Carefully monitor the surveillance data, including data on school absences so that we can identify any potential outbreaks of COVID-19 and learn from best practice. • Explore potential scenarios with education leaders to help further strengthen our response and business continuity plans. • Shetland Islands Council will administer the Transitional Support Fund1 to reduce the pressure on Funded Providers of Early Learning and Childcare. • Continue working closely together to keep arrangements under review and adapt in keeping with national and local Public Health guidance. • Implement testing for staff in schools – this is a Government initiative to allow any staff who work in schools to request a test if they think they have been exposed to COVID-19 but have no symptoms. (Note that this is not available to any other staff).

1 https://www.gov.scot/news/support-for-childcare-sector/ 17

Theme 5: Prevention & Precautions: High Risk Places, Locations & Communities of Interest High risk places, locations and communities of interest may require additional support to stay safe or take the necessary action if someone develops symptoms of COVID-19. This may be for several reasons including: • It is difficult to maintain social distancing. • Settings have been contacted by Environmental Health or Public Health and informed that they are high risk. Employees are required to work within cold or refrigerated sections e.g. food processing establishments. • Multi-occupancy accommodation where more than one household live, with shared facilities or lifts. • Groups of people are coming together for worship. • Groups of clinically or socially vulnerable people are present.

What Shetland Islands Council and Shetland Health and Community Care Partnership have done so far: • We have worked together to put in place streamlined support and assistance for those in need including those who were asked to shield. • The Shetland Coronvirus Hub has provided support and assistance to those in need including the Shielding population – specifically in relation to coordinating volunteering requests. • Supported the enforcement of the lock down restrictions and supported businesses reopening. • Environmental Health have visited high risk businesses either pro-actively or on request to offer further advice in how to comply with COVID-19 regulations. • Environmental Health have responded and acted on reports from members of the public where businesses have not being complying with COVID-19 regulations.

What we will do now: • Continue to proactively engage and prioritise ongoing support for high risk settings based on risk and vulnerability. • Continue to work together to respond, investigate and control outbreaks or clusters of cases. • Continue collaboration with partners including Shetland Islands Council, Police Scotland and Health and Safety Executive to support places to be compliant with legislation. • Continue with a 4Es approach to enforcement (Engagement, Education, Encouragement and Enforcement) with enforcement only being utilised when other methods have failed to achieve the necessary outcome. • Embed the community supports that have been put in place into ‘business as usual’ that can respond to changes in demand as we continue to live with COVID-19. • Work with Shetland Islands Council and other partners, to provide advice and support to businesses. 18

Theme 6: Prevention and Precautions: Port Health A main partner within Shetland Islands Council is the Environmental Health Service which performs the port health function at Shetland’s seaports and airports. Port Health Authorities (PHA’s) enforce a wide range of international, European and domestic legislation at ports and aboard vessels carrying passengers and freight. The primary reason why PHAs exist is to prevent the spread of infectious disease from seafarers and passengers arriving from other countries. International Health Regulations dictate that six monthly inspections of all ships engaged in international trade are carried out by Port Health Officers to ensure that any potential sources of disease are controlled and monitored and that vessels are properly maintained in a hygienic condition.

A well-established process is the requirement for all ships arriving from other ports to submit a Maritime Declaration of Health to the PHA. This is a report on the current health status of the crew and of any passengers on board. This procedure enables arrangements to be made, if necessary, for a Medical Officer and Port Health Officers to quickly board and assess patients and the ship and require controls to be implemented to stop further spread of any disease or the possibility of it being introduced into the local community. Powers can be used to direct or detain the ship or its crew and passengers if this is considered necessary to protect public health. In circumstances that pose an imminent risk to health, the Maritime and Coastguard Agency (MCA) can also assist in detaining a ship until remedial measures have been carried out.

Due to the multi-national origin and movements of crew and passengers on vessels and the enclosed nature of their environment, COVID-19 could easily be introduced and could readily spread through the vessel if proper and timely controls were not in place. This is why ships in particular are identified as high-risk settings for the control of this disease

What Environmental Health have done so far: • Provided support and guidance to Port Authorities, shipping agents and vessels regarding the process for the early alert of suspect COVID-19 cases on board ships arriving in Shetland. • Monitored the health condition of all large vessels arriving in Shetland’s ports. • Contributed to plans and procedures relating to COVID-19 controls at Sumburgh Airport. • Provided advice to SIC’s own ferry fleet regarding cleaning and disinfection procedures. • Continued to provide ship sanitation certification, issued under International Health Regulations, so that shipping could still operate. • In collaboration with NHS Shetland Health Protection and Port Authorities developed a Port Health Incident Plan setting out the local response to a report of COVID-19 case(s) on board a ship or aircraft.

What we will do now: • Continue to proactively engage and prioritise ongoing support to the shipping industry, based on risk, to ensure compliance with International Health Regulations. • Continue to work with NHS Shetland Public Health team and the Port Authorities to effectively respond to outbreaks or clusters of cases associated with shipping. • Continue to monitor the health condition of vessels arriving in Shetland’s ports. • Continue to collaborate with other partners including shipping agents, vessel owners, the Maritime Coastguard Agency, Food Standards Scotland, HSE and other Shetland Islands Council services to ensure compliant with legislation. • Continue with a 4Es approach to enforcement (Engagement, Education, Encouragement and Enforcement) with enforcement only being utilised when other methods have failed to achieve the necessary outcome.

Theme 7: Detection: Test and Protect Test and Protect is a national strategy aimed at managing the spread of COVID-19 by quickly identifying cases of the virus and breaking the chains of transmission. It is not a substitute for the measures already in place, such as physical distancing, good hygiene practices – particularly thorough handwashing – and wearing a face covering when in enclosed public spaces.

Test and Protect is designed to interrupt the spread of COVID-19 in the community by: • Identifying people who have the virus; • Tracing those who have been in close contact with an infected person for a long enough time to be at risk of infection; and • Supporting those close contacts to self-isolate, so that if they have the virus they are less likely to transmit to others. Testing In the community testing aims to identify those who have the virus, so that their contacts can be traced, and they can all be supported to self-isolate to reduce the risk of further transmission. It is also helpful to rule out COVID-19 in people who have symptoms caused by something else, and allow them to continue working or going to school if they are well enough to do so. Anyone in Shetland who has COVID-19 symptoms of a new continuous cough, high temperature (fever) or change or loss of their sense of smell or taste can request a test online. If the test is positive then they will be told to continue isolating until at least 10 days after the onset of the symptoms. Household members will also have to continue self-isolating for a period of 14 days from the onset of the case’s symptoms. All other contacts will be traced and told to self-isolate for 14 days from the last day of exposure. The easiest way to request a test is to go to the NHS Shetland website and click on the ‘Self refer for a COVID test if you have symptoms’ button. Once you have filled in the online form, the local testing coordinator in Shetland will get in contact with you and arrange for your test to be done. They will give you instructions about what will happen next. Usually, this will involve a designated person coming to your house with a self-swab to collect your sample. Testing is processed either through the NHS in Shetland (and in NHS Grampian if needed) or through the UK Lighthouse laboratories, primarily Glasgow. We have tested our system’s ability to respond to changes in demand for testing. For example, we had experienced a surge in demand for testing during August which coincided with the re-opening of schools. This allowed us to get a better understanding of the potential demand for testing and will support our plans for ensuring sufficient capacity for testing during the winter months. Contact Tracing Contact tracing is the next step in the Test and Protect process. A person who has tested positive will be contacted by the Test and Protect (contact tracing) team and asked who they have been in contact with in the 48 hours prior to their symptoms developing. This is in order to identify close contacts. It is important to provide as much information as possible, even if it does not seem relevant. Contact tracing works by identifying people at risk of COVID-19 infection because they’ve been physically close to a person who has tested positive. There may be times when everyone in a particular place will be considered to be contacts, but the usual approach is to identify contacts through careful discussion with the person with the positive test result. This means that you might not be contacted even if you were in the same premises as someone who has tested positive.

What is a close contact? Somebody who has been near someone with COVID-19 and could have been infected. Being near someone means: • Within 1 metre (around 3 feet) of them for any length of time (face-to-face contact) • Within 2 metres (around 6 feet) of them for 15 minutes or more (not necessarily 15 minutes in one go) If you have had close contact with someone who has tested positive, someone from the NHS Shetland or NHS Scotland contact tracing team will get in touch. You will: • Be given advice to help reduce the risk of spreading the virus. • Be advised to self-isolate for 14 days from the date you had the last contact with the confirmed case whether or not you have symptoms and to remain vigilant of symptoms developing. A test should only be requested if symptoms develop because a ‘not detected’ result will not remove the need for isolation. In some circumstances the Test and Protect team will organise for testing of contacts even if they do not have symptoms –this may be because the setting is high risk or because we are dealing with a large outbreak. As above, a negative test does not mean that you can stop self -isolating. The contact tracing team will never ask for details of card or bank account numbers, ask you to provide or fill in social media login details, ask you to set up a PIN, or ask you to download anything. If someone contacts you claiming to be a NHS contact tracer and asks you to do any of the above, they are not genuine and you should end the call immediately.

The Protect Scotland ‘proximity’ app The Protect Scotland app form NHS Scotland’s Test and Protect is a free, mobile phone app designed to help protect each other and reduce the spread of coronavirus. The app will alert you if you have been in contact with another app user who tests positive for coronavirus. If you test positive, it can help in determining contacts that you may have otherwise missed while keeping your information private and anonymous. You can get more information and download the app at www.protect.scot

What NHS Shetland Public Health Team have done so far: • Introduced testing through NHS Shetland for all Health and Social Care staff working in Shetland who display symptoms. • Introduced testing in care homes as in Theme 3 • Commenced testing for hospital patients to help reduce risk of transmission. • Established a local contact tracing team that works alongside the National Contact Tracing Centre. • Worked with partners across NHS Shetland and other partner organisations to agree pathways of support for individuals who find it difficult to self-isolate through the Support Hub described in Theme 8 below. • Provided public communications to highlight the key messages of Test and Protect to ensure it is widely recognised.

What we will do now: • Continue to ensure testing is available to those who require it, responding to changes in Government guidance and best practice. • Implement a local policy that will enable staff who are visiting care homes and providing direct care to residents to be offered a weekly test (in the same way that care home staff are) or a one-off test prior to their visit. • Continue to ensure our contact tracing service is robust to cope with spikes in demand. • Monitor information that we gather from confirmed cases and close contacts to identify and manage outbreaks and clusters.

Theme 8: Care for People We have been supporting and will continue to support vulnerable local people to get help and stay safe. This includes people who are vulnerable or have been self-isolating due to higher risks associated with underlying health conditions, age or other risk factors. We have identified, risk assessed and responded to the needs of Shetland’s vulnerable groups. Support for these groups can include: • Public Protection • Emotional support • Food and prescriptions • Childcare / family/ domestic support • Personal care • Emergency funds • Housing and fuel What Shetland Islands Council and the Shetland Community Health and Social Care Partnership have done so far: • Supported the establishment of a dedicated crisis support phone line to support people who have been shielding or non-shielding. • Co-ordinated joint work across the system of health, adult social care and local authority services to ensure robust access to advice, guidance and support. • Embedded robust monitoring to understand and address local need and requirements of residents. This has allowed for focused support and communications to specific communities and individuals where risk is considered higher or where need is greater. • Established flexible staffing capacity to support and assist those in need linked to changes in demand. • Trained staff to provide support to people to allow them to self-isolate and access services to meet their individual needs, which includes volunteer support, assistance with debt and benefit advice, a listening ear and support for mental health or loneliness. • Provided alternative housing options to support those experiencing homelessness or domestic abuse. • Facilitated the roll out of devices and digital connectivity supporting those who are at highest risk and who are not currently digitally connected. This is being achieved in conjunction with a range of community partners. • Developed and strengthened links with people in our communities, including a high number of formal volunteers that have come forward, who are willing and able to provide support in a range of different ways to those in need, building on the quick response to COVID-19 by Shetland communities. What we will do now • Maintain and increase integrated work across health, adult social care and local authority services to promote community resilience and ensure residents have access to the right advice and support when needed. The Community Coronavirus hub and the Care for People Team will continue through the recovery stages. • Use local data and intelligence to target specific locations and communities who have a greater need for support and assistance due to socio-economic factors, the long term impact of lockdown and the immediate need which may result from further local outbreaks. • Continue to work with community and voluntary sector partners to assist in coordinating and support of residents. 24

• Ensure that communication and information is always available, clear, and accessible. • Develop the existing dedicated phone line to continue to receive referrals for shopping, food or specialist services as required, supporting residents to self-isolate, shield and support themselves to remain safe and well.

Theme 9: Local Governance Sound and effective governance arrangements at strategic, tactical and operational levels are critical in delivering our outbreak response for the Shetland.

Shetland Islands Council Environmental Health is the regulator in retail, hospitality, warehousing, most sport and leisure settings, residential accommodation and childcare. The Health and Safety Executive (HSE) may be able to input to any Problem Assessment Group or Incident Management Team established where the workplace(s) under consideration is one which falls to the HSE for enforcement.

The HSE shares workplace regulation with local authorities. Broadly put, HSE is the enforcing authority in manufacturing, schools and universities, custodial setting and health and social care.

HSE may be able to help public health officials to understand whether the workplace is likely to be a source of infection transmission or whether they should be looking for other possible connections between cases.

Local flexibility within our governance arrangements is key to ensuring our response remains proportionate and effective. We will continue to refine local arrangements to best meet the needs of Shetland.

Working in partnership, NHS Shetland, Shetland Islands Council and Shetland Community Health and Social Care Partnership have: • Activated emergency plans, monitored, and reviewed likelihood and impact of COVID-19 related risks through horizon scanning and existing data, activated business continuity plans. • Built on already established multi-agency partnerships to strengthen shared leadership during the initial response phase to COVID-19, enabling swift and effective decision making. • Established new multi-agency working groups as appropriate to facilitate data sharing and informed decision making.

Communicating Our Plan We want to provide clear messages on what to do to stay safe and well, where to get support, and aim to reach everyone, no matter where they live, work and travel.

Our aim is that everyone in Shetland, through clear messaging, will be able to: 1. Help prevent the spread of the virus. 2. Understand what to do when they have symptoms; and 3. Be included in our local pathways to identify and contain an outbreak. 4. For our plans to be successful, local people, communities, partner agencies, and wider businesses and organisations must recognise and trust our approach. This means our communications plan is not just about sharing key messages. It is also about listening and engagement. NHS Shetland will lead on communicating measures taken to control any local outbreak, including updating the public on the number of positive cases, tracing arrangements and Test and Protect. During a local outbreak, the Incident Management Team (IMT) will consider any key messages that need to be communicated with the public and local businesses. Channels for communicating with the public include media releases, websites, and social media. In some circumstances, it may be appropriate and necessary to contact specific employers, premises and individuals directly, where for example, they require to close. This may be in person or through available contact details. In such instances, contact will be made as soon as reasonably practical by the relevant partner within their available resources. It will also be reliant on having up to date contact details and the availability of those employers, premises and individuals. If we discover that contact details are outdated, we will take the opportunity to update these where possible.

Our plan is to: • Ensure key prevention messages e.g. physical distancing, hand hygiene, use of face coverings etc, are heavily and consistently communicated by local organisations. • Use all traditional communication channels – local media, other corporate websites, and social media. We will maintain joint communication relationships across local partners. • Provide advice – aiming to ensure everyone who becomes unwell with symptoms of COVID- 19 knows what to do. This includes getting tested and the importance of self-isolation to prevent the spread and how to get help to stay safe. • Focus on outbreak management through local communication e.g. press releases, broadcast interviews, use of social media accounts. • Tailor communications to ensure that everyone knows what to do in the event of an outbreak. • Develop a suite of targeted resources, like those developed locally to support Test & Protect to support high risk places and locations. We will promote the work of Incident Management Teams as appropriate and work collaboratively with local partners and agencies as appropriate. • Continue to develop working collaboratively as a member of the Public Communications Group (a sub-group of the Highlands and Islands Local Resilience Partnership with Local Authority partners and other Category One responders to ensure a consistent message is communicated to the public. • Continue to be well connected with partners in other health board areas and Scottish Government as members of the NHS Scotland Strategic Communications Group to ensure reciprocal support and good lines of communication.

Where do I go for more information? General information on Coronavirus (COVID-19): https://www.nhsinform.scot/coronavirus

If you are a member of the public and showing symptoms of COVID-19, you can book a test by visiting: https://www.shb.scot.nhs.uk/ and click self-refer for COVID test.

If you have concerns about a business in Shetland that is not complying with regulations you can report the breach to Shetland Island Council Environmental Health Department: [email protected]

Guidance for businesses on the collection of customer details: https://www.gov.scot/publications/test-protect-multi-sector-guidance-collection- customer-visitor-contact-details-july-2020/

Information for carers: https://www.healthyshetland.com/helpful-links; https://www.shetland.gov.uk/communityplanning/CoronavirusSupportForCommunitie s.asp

If you are a Shetland business seeking advice during COVID-19 restrictions, please e-mail: https://www.bgateway.com/local-offices/shetland/local-support; [email protected]; https://www.shetland.gov.uk/economic development/EconomicDevelopmentContactUs.asp

Details of regulations and emergency restrictions agreed by government to protect public health, while providing support and advice to businesses across Shetland: https://www.legislation.gov.uk/ssi/2020/103/contents/made

General information on the Scottish Government’s Route Map for easing lockdown restrictions and the response of Shetland Islands Council: https://www.shetland.gov.uk/coronavirus.asp

If you have any feedback on this version of the Outbreak Control Plan, please contact: [email protected]